Date of Award

Spring 2019

Document Type

DNP Project Restricted

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chairperson

Cheryl Monturo, Ph.D., MBE, ACNP-BC

Committee Member

Manuel Betancourt, M.D.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) hospital readmissions are a significant burden to the U.S. health system. Pulmonary rehabilitation (PR) is a proven strategy to improve disease management and reduce COPD-related hospital readmissions. This quality improvement (QI) project evaluated the effectiveness of a rural hospital’s COPD readmission reduction program through referral to PR.

Methods: Using the electronic health record (EHR) a retrospective chart review was performed to establish the hospital’s baseline COPD readmission rate. The medical records of Medicare patients aged 65 years and older admitted with COPD exacerbation were reviewed to identify PR referral rates. Patients who participated in PR were evaluated for readmission and to identify variables evident in those who were and were not readmitted.

Results: A total of 330 patients were admitted with COPD exacerbation in 2017 of which 65, or 19.7%, were readmitted within 30 days. The average time to readmission was 12.57 days. Seventy-nine patients were referred to PR during a 9-month period with six patients enrolling in PR. One of the six patients was readmitted during the PR program. Multiple missing data were encountered during data collection.

Conclusion: Local COPD readmission rates are consistent with national readmission rates. Participation in PR appears to reduce hospital readmissions although PR uptake rates were too small for statistical inference. A QI project is proposed using the Plan-Do-Study-Act framework with the goal of improving referral and uptake rates in PR after hospitalization for COPD exacerbation.

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